The Social Determinants of Trauma: A Trauma Disparities Scoping Review and Framework

Abstract

The drivers of trauma disparities are multiple and complex; yet, understanding the causes will direct needed interventions. The aims of this article are to (1) explore how the injured patient, his or her social environment, and the health care system interact to contribute to trauma disparities and examine the evidence in support of interventions and (2) develop a conceptual framework that captures the socioecological context of trauma disparities. Using a scoping review methodology, articles were identified through PubMed and CINAHL between 2000 and 2015. Data were extracted on the patient population, social determinants of health, and interventions targeting trauma disparities and violence. Based on the scoping review of 663 relevant articles, we inductively developed a conceptual model, The Social Determinants of Trauma: A Trauma Disparities Framework, based on the categorization of articles by: institutional power (n = 9), social context—place (n = 117), discrimination experiences (n = 59), behaviors and comorbidities (n = 57), disparities research (n = 18), and trauma outcomes (n = 85). Intervention groupings included social services investment (n = 54), patient factors (n = 88), hospital factors (n = 27), workforce factors (n = 31), and performance improvement (n = 118). This scoping review produced a needed taxonomy scheme of the drivers of trauma disparities and known interventions that in turn informed the development of The Social Determinants of Trauma: A Trauma Disparities Framework. This study adds to the trauma disparities literature by establishing social context as a key contributor to disparities in trauma outcomes and provides a road map for future trauma disparities research.

Social determinants of trauma care: Associations of race, insurance status, and place on opioid prescriptions, postdischarge referrals, and mortality

“…Contrary to expectations, Black patients had lower overall mortality rates compared with White patients after adjusting for demographic and injury characteristics. However, the main effect for race was no longer observed in the logistic regressions that carefully adjusted for insurance alone (model 2) and in combination with socio-contextual factors (models 3 and 4), in line with recent methodological recommendations for trauma disparities research 4 . Previous studies have reported that racial disparities in mortality rates are diminished when controlling for insurance status 36 and eliminated after adjusting for both insurance status and neighborhood poverty 29 .…”

“…Traumatic injuries disproportionately impact racial/ethnic minorities, the poor, and the uninsured 4 . Disparities based on race, SES, and insurance status, have been documented for a range of health outcomes across the continuum of trauma care 11 .…”

Association of the Affordable Care Act Medicaid Expansion with Trauma Outcomes and Access to Rehabilitation among Young Adults: Findings Overall, by Race and Ethnicity, and Community Income Level

“…8,9 The mechanisms driving disparities in access to care and outcomes after traumatic injury are complex, with potential contributors, including health insurance coverage, but also many other systemic, cultural, and geographic factors. 10 The ACA was intended to improve access to healthcare and health outcomes by extending health insurance coverage to millions of previously uninsured Americans. 11 In addition to a health insurance mandate and newly created subsidies, the ACA included a provision that required states to expand Medicaid coverage starting in January 2014 to all nondisabled adults aged 19 to 64 years with incomes up to 138% of the federal poverty level.…”

Development and Pilot Testing of a Five Item Traumatic Stress Screener for Use with Adolescents in Pediatric Primary Care

“…Indeed, structural inequities arise from exploitative power dynamics (Laster Pirtle, 2020; Prins et al, 2021), as do most types of trauma. Prejudice, discrimination, and systemic or structural inequities such as policies, practices, and behaviors that perpetuate disparities in wealth, housing, education, employment, healthcare, and opportunities can be traumatic themselves (Mikhail et al, 2018). Moreover, they create conditions that increase the likelihood that low-income and BIPOC youth will be exposed to other traumas, such as violence and death (Knopov et al, 2019; Wilkins et al, 2019).…”